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News - May 2007
NICE amends its clinical guideline on depression and anxiety
NICE has amended its clinical guidelines on depression and anxiety, first published in December 2004, based on safety advice issued by the MHRA on the prescription of venlafaxine. The main changes to the guidelines are the considerations that need to be made before prescribing venlafaxine.
The guidelines no longer recommend that venlafaxine treatment should only be initiated and managed by specialist mental health medical practitioners, however, their supervision or advice is required when prescribing high doses of venlafaxine (³300 mg/day).
Before prescribing this drug, practitioners should:
- consider the increased likelihood of patients stopping treatment because of side-effects, and its higher cost, compared with equally effective selective serotonin reuptake inhibitors (SSRIs)
- ensure pre-existing hypertension is controlled in line with the current NICE guideline on hypertension, as venlafaxine should not be prescribed for patients with uncontrolled hypertension
- assess a patient's risk of suicide as venlafaxine is more dangerous in overdose than other drugs routinely used in primary care.
After a patient has been prescribed venlafaxine, practitioners are advised to:
- check the patient's blood pressure on initiation and regularly during treatment—if there is a sustained increase in blood pressure, the dose should be reduced or discontinuation considered
- monitor patients for the signs and symptoms of cardiac dysfunction.
The depression guideline also clarifies the use of antidepressants, especially in patients with cardiovascular disease. When a decision has been made to switch to a second-line antidepressant, a different SSRI or mirtazapine are recommended as reasonable choices, but consideration may also be given to moclobemide, reboxetine, and lofepramine. Other tricyclic antidepressants (except dosulepin) and venlafaxine may be prescribed, especially for more severe depression, although these therapies should not be prescribed for patients with a high risk of serious cardiac arrythmias or recent myocardial infarction.
NICE targets smoking cessation in its public health guidance
A public health intervention guideline, which provides advice on the support that smokers should be offered in their workplace to help them quit smoking, has been published by NICE. Recommendations for employers include the provision of information on local smoking cessation services, and allowing smokers to attend clinics during working hours without loss of pay.This guideline follows the publication in 2006 of the NICE guideline on Brief interventions and referral for smoking cessation in primary care and other settings.
Public health intervention guidance on preventing the uptake of smoking among children and young people is planned for publication in June 2008. NICE is also developing public health programme guidelines—guidance on the optimal provision of smoking cessation services, with particular reference to manual workers, pregnant smokers, and hard to reach communities, is due to be launched in November 2007.
Asthma care report and pack published by Asthma UK
Asthma UK has launched a report, The asthma divide: inequalities in emergency care for asthma, which highlights a six-fold divide between those PCTs with the lowest and highest number of emergency hospital admissions for asthma. The region with the highest admissions is North-West England, where rates for asthma are 65% higher than in the East of the country, which has the lowest numbers.
National guidelines for the management of asthma state that patients with the condition should:
- expect it to be adequately controlled by their medicine
- expect to be free from symptoms and restrictions on their lives
- not need emergency treatment if appropriate routine care is given.
The Asthma UK report recommends that all people with asthma should receive easy access to a healthcare professional with specific asthma training, and a timely and accurate diagnosis of asthma. In addition, they should receive regular and proactive asthma reviews, and be offered a written personal asthma action plan.
To support healthcare professionals in the provision of asthma care, and to help reduce emergency hospital admissions, Asthma UK has launched an Emergency Asthma Care Pack, which shows the process of care from first presentation of the patient, to follow-up arrangements and discharge. The pack contains guidance on emergency asthma care and templates that can be adapted to an individual setting, including an assessment form, discharge letter, patient group directions, an audit tool, training slides, and patient information booklets.
Model letter available to help practices ensure PCTs are following PBC guidance
The Department of Health guidance Practice based commissioning: Practical Implementation, which was published in November 2006, set out a number of new or reinforced entitlements for practices and responsibilities for PCTs. Practices should use this guidance to fully understand the terms of their engagement in the initiative as well as those of PCTs. In many areas, an extra push to ensure that PCTs are fully signed up to making practice-based commissioning work may be necessary. Therefore, the General Practitioners Committee has developed a model letter that can be sent to PCTs to highlight a practice's entitlements. This can be used by practices if they are concerned that their PCT is not following the national guidelines. This letter can be accessed on the BMA website.
BTS and GPIAG form joint committee to help integrate respiratory services
The British Thoracic Society and the General Practice Airways Group have formed a joint committee to drive high quality patient centred care across the traditional boundaries of secondary and primary care. This joint work has been named IMPRESS—IMProving and integrating RESpiratory services in the NHS—the aims of which are to provide leadership, advice, and support to members to provide integrated care for people with respiratory disease in local settings. Much of the initial work of IMPRESS will focus on COPD in the initial stages, and the joint committee will work closely with the NSF for COPD team on this. A glossary has been developed by IMPRESS to help clinicians in respiratory care to understand the terminology and processes in the NHS.
A self-assessment tool to support commissioners of children's and young people's health services has been developed
The CD-ROM will allow commissioners to assess their capability to deliver high quality, accessible, children and family focused services.
The DH has published Operating framework 2007/08—PCT baseline review of services for end of life care
This document will help PCTs to review these services prior to the End of Life Care Strategy due to be published later this year.
A Healthcare Commission survey indicates that the NHS is meeting standards for diabetes check-ups
In the largest ever diabetes survey in England, almost all respondents said they had an annual check-up to assess their condition.
www.healthcarecommission.org.uk
Medicine Use Reviews (MURs) are reported to help people with asthma
Research has shown that, following a MUR, patients had better understanding of their condition and felt more confident about managing it.
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Guidelines in Practice, May 2007, Volume 10 (5)
© 2007 MGP
Ltd
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